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.._..�...... �..-w...�..�,—....�..�. a+.r..!(R�_4!f>avRa�llia\ �1�fd�.y^ <br /> Stele off�aalu.'tprnier—Heslfh and Welfare Agency <br /> F m q�d OMB No.¢050-0039(Expires 930.91) -� <br /> Department of Health Services <br /> Pleaes prig)or type. (Form tlaefOned for use on elite(12-pitch typewriter). Toxic Substances Control Division <br /> NIFORM HAZARDOUS f. Generator's US EPA ID No. Sacramento,California <br /> WASTE MANIFEST DocumentN,. 2. Page 1 <br /> Document No. Inlormelion in the shaded areae <br /> 3. Generaloe's Name and Mailing Address ` 1 3 7 3 4 7 6 f3 of is not required by Federal law. <br /> ASCO/DELTA A. Stale Manifest Dpcumepl Nymgpr� <br /> 705 t7, CARLTON AVE„ STOCKTON, CA 95203 B. StateGsnerator'a10 10 <br /> a. conerator•a Pbooe(209) 941-4111 <br /> h $. Tranaporer I Company Name e. US EPA ID Number 3 6 0 1 7 1 0 9 <br /> CHEMICAL WASTE MANAGEMENT C. Stale Transporter's lD <br /> MANAGEMENT A t-- <br /> h 9 6 S D. Transporter',Phone <br /> y 7. Transporter 2 Company Name r,- <br /> e• US EPA ID Number E. Slate Transporter'a ID <br /> 0 <br /> m F. Trans orter's Phone <br /> .- 9.1 Designated Facility Nam a end Sile Aetlreaa t0. US EPA ID Number <br /> CHEMICAL WASTE MANAGEMENT G. SIalaFaeility'sID <br /> v 35251 OLD SKYLINE ROAD A 64 1 1 7 <br /> KETTLEMAN CITY, CA 93239 AK Facility's Phone <br /> ¢ T 0 0 4 6 1 3 <br /> OLL 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) f2. Containers 13. Total 14, <br /> < e. No. Type Ouenlity Unit !.Waste No. <br /> U <br /> Z i RASTE FLAMASLE LIQUID, NWt/Vol <br /> ,Q,S , FLAX EL State <br /> i" N LIQUID UN 2993 (DO01 , FOOS) y 00 461 <br /> 3 A' her <br /> 64 E b.3iAZARDOUS WASTE SOLZD, N,O,S , 0 D 0 0., .,,F3 0 'G BOvi — F005 <br /> A yA9189 , ORM—E, state <br /> T (EMPTY CRUSHED CONTAINTRS LE 3 513 <br /> e R q Tit' oo 0 0W 0 3 7 9 EPA/Other <br /> -�- State <br /> d. <br /> EPA/Other <br />_ M� <br /> State <br /> _ EPA/Other <br /> J. Additional Descriptions for Materials Liated Above <br /> A), PROFILE #E02623SPO K. Handling Cadea for Waatea Liatee Above <br /> a• b. <br /> BY. PROFILE #G16634SFO <br /> C. d. <br /> 15. Special Handling Instructions and Atltlitional Information <br /> CLOVES, GOGGLES , AVOID SKIN CONTACT <br /> 18. <br /> GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of thin consignment are fully and eccuralely described above b <br /> and are classified,packed.marked,end labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> national government regulations. <br /> It I am a large quantity generator,I Certify that I have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> Present and future threat to human health and the environment;OR,if i am a smell quantify generator,I have made a good faith effort to minimize my waste <br /> generation and select the beat wsale management method that is available to me and that I can afford. <br /> Printed/Typed Name <br /> ALANT. ESTF,3 (__ f("4� ! i �.r'.._ ti'��i f^ Der 'Yee, <br /> 1'._ <br /> T �� P' fi <br /> 17. Transporter 1 Acknowledgement of Receipt of Materials n <br /> R <br /> A Printed Ty ad Name <br /> N signature Month De <br /> S `./,. � ,. , L � t ' , y Yea, <br /> p 18. Tranaportec.2/Acknowled9emegl of Receipt of Materials (/ <br /> T Printed/Typed Name <br /> E Signature <br /> VV Mont''j Day Year <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C - .. <br /> L <br /> I 20. Facility Owner or <br /> T Operator Cerlilleation of receipt of hazardous materials co <br /> y Printed/Typed Name vered by Ihie manileal except ea noted in Item 19. <br /> signature <br /> Mont Day Year <br /> 022A(1/88) <br /> 700-22 Do Not Write Below This Line <br /> 9.88)Previous editions are obsolete. <br />